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tv   [untitled]    February 21, 2011 12:00pm-12:30pm PST

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you are getting about the men this model. i know i certainly would like to learn more about how it works, to learn more about what its implementation will look like in san francisco, and i think that the more that we are involved, the better it will be, and it is certainly something we need to think about as we go forward with the budget process, which is already starting, because it will cost some money to implement as well. >> i appreciate the support from the board on this. it would be great to have that support. supervisor campos: and the last thing, i have to say that on the mental health complex issue, to
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end up having the load on that is impressive. having served on the commission, it is impressive to see that level of unity on something as complex and sensitive of that, so i'm very proud to see that. >> thank you. i think we have that unity because we had a room packed of mental health stakeholders were unified in asking for the passage of the resolution as well as support from the chief and director, and that really helped push the commission to say yes, we are all in this commission together. >> adding that is important. the involvement by the director and chief went a long way in making that happen, as a thank- you to both the director and chief for making that happen. supervisor mirkarimi: some of the stakeholders are here today, and they will speak as well. supervisor cohen?
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ok, thank you very much. >> i will send you more material about the memphis models of you have it, and i should qualify that my opinion on the taser is my personal opinion, and you will find that the commission's overall opinion next wednesday. supervisor mirkarimi: is inspector dunn here by any chance? andhele -- and helena brook, mental health ward. >> thank you for having this hearing. i'm really excited and pleased by the work that angela and the police commission did to address this issue. i did some squawking, as you know i'm prone to do, in june when the training that has been going on for 10 years was cut, but it was not just interest to the general public at that time, but i'm really glad to see this
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happening. but having coordinated the training for 10 years, having worked with almost 1000 police officers who came to the training, a large majority because they wanted to, because they wanted the information about mental illness, and they wanted to learn more because of the time -- you get about eight hours, i think, in your first academy experience. by the time you finish that, you forget most of it. many officers who have been on the force for more than 40 years said it was the best training they have ever had. i want to really salute the police department for having that training for 10 years. i believe, and it is one of those things you cannot research -- how many times that the police officers who went through that training be escalated the situation before
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it ever came to any attention or any problem -- de-escalated the situation. because they have had that training. that training was actually based on the mend this model. it is the same actual training that they do in memphis. the difference is only the the community decision 10 years ago was to train the entire police department, since we have such a high number of mentally ill in our city. the highest number of people taken to the hospital as a danger to themselves or others or gravely disabled, and police officers tend to have to respond to more situations where a person is also under the influence of substance abuse, has had a recent incidents of violence. if i just really think that the training has been very good and very effective in ways that we probably do not even know. i have -- you're just interest
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in reading over the last 10 years. i would have them right out situations that they had encountered with a person with mental illness. they are very different in the city -- than the situations we encounter in mental health. one of the most graphic was a man in a wheelchair in the middle of traffic, and he had a colostomy bag, and as the police tried to get near him to try to get him out of traffic, he was throwing the contents. that does not happen to us in the mental health building. they have a lot of situations to deal with that are very different. what i hope happens out of this is much more collaboration and more focus and attention on a 24-hour mobile crisis treatment team, on expanding aging care, which is 24 hours, but only has
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12 beds. i think we only have 18 beds. in mental health, the resources have been cut in so many ways that police do not have options after they stop a person. a number of stories that we heard of police driving around and around until site emergency went off red alert and with a person in serious crisis in the back seat of the car because they could not take them to sec emergency because it was too full. we really have to collaborate response from different departments. from reentry, from jail, from mental health, from the full
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department of public health, the department of human resources. they have all really got to be working together because the police cannot be out there working alone. it is really not fair. supervisor mirkarimi: i very much thank you for that presentation. from my experience when i went to the san francisco police academy, that was not part of our training at all. it was not part of the coast- curriculum, even though there were some modifications to the curriculum here in san francisco to add to more specialized training, and we had that, but on mental health, that was not part of the eight-hour block. so of that was part of the primary, what about the veteran officers? how about the veteran officers who have already established their habits? been in the departments, and influenced by certain practices? how would the navy influenced after they had become more molded than the academy recruit
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that was just trying to get through in the launch of their careers? >> a couple of things -- one thing that the chief did while she was here is on basic mental health information and on mental health disorders because we could not move fast enough for the 40-hour training, and she wanted to have all of the officers have some basic training, but a thing -- i think where the 40-hour training did make some changes was the first phase was basically information about mental health. the second day was a visit to clinics and media clients, having clients speak from a panel about what it is to have a mental illness, and the third day was more information. the fourth day was a full day with a person from the academy and a person from mental health and doing role-playing and very specific techniques for de-
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escalating. what we heard so much from officers was in the first part, not having information -- in other words, if they come upon a scene and start with the usual command and control response to any person does not respond at all as predicted. in other words, if a police officer comes up to me and says, "standstill, touch your toes, jump," i'm going to do all of those things. of the that a police officer and respond in whatever i asked to do, but a person in a serious mental health crisis might not even be aware that as a police officer. they might be hearing voices saying that that is someone out to hurt them. a lot of that training provides information, just a different tool to evaluate a situation. if a person, for infants, is not appearing to see that you are a police officer and as perhaps
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looking up to the left or right like they are listening to something, tell them that it is okay to ask the person -- if they are hearing voices and ask a person with the voices are saying. if a person appears suicidal, ask them if they are thinking of killing themselves. people are very hesitant, police officers included, if they are planning it, whether they will give them an idea. and that is not true. they shared with us that having the information and then meeting to people -- meeting people with mental illness -- many officers if they do not have a person with mental illness in their home do not know that mentally ill people can be very intelligent. that they are meeting in person at their very worst moment. but that in recovery, people hold jobs, contribute to the community, so seeing the full range of what this person is capable of was very helpful to them.
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supervisor mirkarimi: it's psych emergency at san francisco general is reducing down to 18 beds, and as you said earlier, police will be somewhat disabled from not being able to -- if in fact they are at or beyond capacity for both beds and what other services, what do you anticipate happening then? >> pretty much what has been happening. the 18 beds is in sight emergency. i did not know what their full capacity is. but they will make decisions based on, you know, what they can do with a person. supervisor mirkarimi: but the police department has the mandatory power to commit somebody for up to 72 hours. isn't that correct?
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>> that is correct. >> yet, if they reduce that level of access or resources for the police to be able to bring somebody, then, it is to one of the non-profits, i believe. is that not correct, too? >> if they decide that someone needs to be 5150ed, other than dole urgent care, there is nowhere else to bring them. let me correct that -- they can bring them to st. francis. they can bring them to some of the other hospitals. what we are hearing is back the other hospitals are not very responsive to our clients coming, and often, they will not necessarily refuse them, but make it very difficult. then, an hour or two we will later, an officer will be called again for the same person because the other hospitals have actually put them out.
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supervisor mirkarimi: do you have any specifics on the 5150 population? >> yes. we did -- we have done a couple of research studies. one in 2005 in which we look at all the 5150's over a three- month time and were comparing them and found that the police officers were more often people who were also under the influence of substance abuse who had recently within two weeks had a violent incident. in terms of the overall calls per month, as a look at my notes here, i do not have the memorized.
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the san francisco police informant has from 1 to 20 interactions per share with people with mental illness with an average of four contacts. a lot of that depends on different areas of the city. supervisor mirkarimi: what was the first statistic? >> one to 20 interactions per shift. it hundred 5911 calls per year or 30 per day. with approximately 8 per day resulting in a 5150 -- supervisor mirkarimi: do what we have any idea of the repeat offenders? >> i do not have an update, but -- actually, i do, i do not have that in front of me. we did this from a different perspective. we did a study over three years
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in 2009 of 5150's intensely looking at what the cases were about, what the person was complaining of, and such, and to determine how many of those could have gone to dual urgent care instead of psychiatric emergency, and we came up with about 2/3 of those could have gone to build urgent care. within that study, which i'm happy to forward to your office, it does detail how many of the people were repeat calls and what specifically the numbers from each supervisory district as well. supervisor mirkarimi: maybe you can provide that to our offices. >> i would be happy to. supervisor mirkarimi: thank you. appreciate it. supervisor campos: i do not have any questions. i simply want to make the point that, as is the case with anything dealing with public safety, whether you are dealing with mental health issues or
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something else, there's the policing peace, which i'm glad we are addressing the fact that we are following a model that will incorporate best practices and will, among other things, provide better training to police officers, but i also think that there has to be a prevention piece, and that is where mental health services comes in. you can do everything right on the police enforcement peace, but if you are not providing those services and protecting those services, you are going to have a problem. i hope that is something we keep in mind as we move forward with our budget. we have to make sure that we move on parallel tracks because of the services are as important as the other pieces. supervisor mirkarimi: thank you. we are quite agree.
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thank you very much. >> thank you. [inaudible] supervisor mirkarimi: yes, please. lisa hoffman? thank you for your patience and for being here. >> thank you for inviting me. good afternoon. i just wanted to talk a little bit about the 911 communications because that is my field of expertise. ordinarily, 911 dispatchers in the state of california for debate in the peace officers standards and training program. that training is reimbursed by the state of california. our dispatchers go on to receive about 32 weeks of on-the-job training, working one-on-one with a public safety dispatcher that his experience and a communications training officer. unfortunately, there is not a lot for widespread embrace men of looking into enhancing the mental health training for dispatchers on an ongoing
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program. we can solicit that. they reimburse, and they also reimbursed through the peace officers using the men this model. santa clara county uses the memphis model, and they have a reimbursement program. imagistic in the commission hopefully seeking dispatchers' inclusion in the program because oftentimes, we are considered an agile, and many times, we do not find out about the programs until it comes to somebody's attention or alertness reviewing meeting minutes, and that is why ask to be here today. supervisor mirkarimi: in many ways, you really are the first responders. you are right. people sort of do not include that calculation in these normal discussions, but dispatchers really are. >> our dispatchers are very much affected by this program. the reason i say that is because they are not just police dispatchers. many times, they are giving medical instruction to somebody
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who is trying to aid somebody who is having a mental health crisis and also a medical condition from that crisis. it could be drug or alcohol- related, our dispatchers are very much emotionally tied to the issue, and they want to get more training. like every other department, ours is suffering from budget concerns, but that does not eliminate my desire to make sure my dispatchers get the best training possible and that we consistently work hand-in-hand with the police commission and fire department to make sure we are getting the best training for our staff. supervisor mirkarimi: what would you say in terms of trend? might be static, increasing, or decrease in, in terms of the dispatcher interface with people will call in about somebody in a mental health crisis. >> unfortunately, i cannot give you a trend because they do not know the statistics. supervisor mirkarimi: anecdotally is fine.
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>> one officer on the street has wanted 20 contacts per shift with a mental health patient, there are only 10 dispatchers answering the phone, so you can imagine that volume. you have 75 or 100 officers on the street at any time, the dispatcher is taking that and considerably expanding their contact with mental health patients, whether it be someone who is calling in because their child is out of control of di to some type of medical condition that is enhanced by the mental health problem, or there is an elderly person who has -- over time, their mental health abilities have digressed, and the care giver of a child is trying to deal with their elderly parents, who they are responsible for periods of our staffers have been given instructions to keep them alive while we get to patient care, and many times, they are combative, said the dispatcher has to play a dual role. they are asking as an emergency
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dispatch instructor and try to get the correct resources for the patient here not only that, but we have to keep track of the psychiatric emergency system, and we have to let officers know when they are in the red zone, meaning they cannot take any more patients, or they are at a level where there are very few patients they can take, because we do have a large complement of people that need that assistance. supervisor mirkarimi: any idea how many times we may have reached that ceiling in a year? i would love to see that. >> i'm not sure if we keep that statistic. we do have a sign up on the wall that tells us what the status is so any dispatcher in the room can see that. supervisor mirkarimi: when i was at the police commission hearing, that did not come out. >> i can find out where i can get the statistics if i do not personally have them. i think we logged in, but i want
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to make sure that they are empirical and not anecdotal. supervisor mirkarimi: that would be helpful. 120 hours post-training, is that combined? in a consecutive three-week process? >> yes, we do a three-week academy. we call it an academy, and it is 120 hours. we have to agree that we will follow the guidelines and mandates. we do that training at our facility in our training room. once they successfully complete the process, they migrate out on the floor where they work one- on-one, and it takes about three rotations of four weeks in each rotation to where they are qualified to answer phones, but we do not allow them to answer phones on their own, and and then migrate into a time where we monitor them one-on-one to make sure they are capable of understanding the process. once that are successful, we allow them to answer phones on their own while we bring back into the room here at all in
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all, it takes about 11 months to fully train a 911 dispatcher. supervisor mirkarimi: the funding needs you were referencing as the commission was contemplating how they would be able to assume the memphis model for dispatchers, what with that funding piece look like? >> depending on the amount of training that is involved, normally, i send my dispatchers to 24 hours of training every tip will years, and that is mandated to make sure that they keep current in their continuing educational professionalism. if we were to include, asking if we could expand that to include the mental health component, i'm sure they would allow us to do that instead of destroying the updated training. supervisor mirkarimi: i absolutely think we should do that, and i would like to help support that for the commission as well, but all of this circles
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back to us anyway. >> exactly. we just want to make sure we are included. we are not whining about this. we are forgotten, and that is a good thing. we want people to not have to think about who they are talking to. a lot of times, there will be decisions made, but we are not included. we did find out about these things, but we do want to be included. we want to be part of the solution. we do not want to be a hindrance. supervisor mirkarimi: i think this factors continue to make a crucial difference, and people take them for granted, just because it is a seamless part of that experience, making a phone call and dispatching emergency services or police, etc., and forget about the role of the dispatcher, but i agree with you. they cannot be forgotten, and they need to be included in this discussion, in a budgetary way.
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colleagues, comments or questions? thank you very much. appreciate your time. >> i will send it to your office. i will share with my colleagues. thanks for your time here. is director murdoch here by any chance? thank you for your patience. >> thank you. i'm with the department of public health community behavioral health services, on behalf of joe robinson, and i would like to say that the department of public health is very enthusiastic and very excited about the idea and the proposal to implement the memphis model and working with our colleagues in the police department and police commission to ensure that we are able to create a very robust, very -- a program that is very responsive to the needs of what is oftentimes a very vulnerable
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population, and as someone who attended the police commission last week, i have to say that it was probably one of the best commission meetings i have ever attended. not just in the police commission, but across various city departments. the department of public health is committed to dedicating a senior staff member to this effort has decisionmaking authority, will be able to meet with the police commission and chief with regards to a search for a cit coordinator. we are happy to be part of the process. we want to be able to work closely with the police department. many aspects of our relationship are very positive and very productive. we are happy to be part of the process, and we encourage it to move forward. supervisor mirkarimi: i made reference to this, so it would probably be a great time for you to address it. i want to be careful not to
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overlap the urgent care model. there have been times in the not too distant past that measures to reduce the beds in the psychiatric unit had come before us, and there had been a spirited discussion about whether that was the right thing to do or not. how does that fold in into this discussion right here? when the terrain of san francisco is that there are quite a few people with mental health needs that are engaged by the police department. the police department needs to take people to our public health system. based just on the population of those needs, those people, what do you say to that? >> we had an opportunity to speak -- to meet extensively
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with dr. dupont and major cochrane from the memphis police department when they came to stand in cisco, and one of the things they told us after they had visited clinics and visited some of our treatment venues or given information on the spectrum of care and system of care that we have in san francisco -- one of the things they said was that it is very robust, very strong. this is many times the amount of resources and services that we have locally in memphis, so what that said to us is that we need to work better in terms of our coordination, in terms of optimal utilization. the department has worked very hard over the last 10 years to create a matrix of services, to respond to individuals who may be having a psychotic episode, and i can go through some of those venues if you are interested. the first that has been mentioned is the urgent care
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clinic, which is a treatment venue located in the south of market district, located by the progress foundation. it does have an overnight capacity of 12 beds, but it operates as an outpatient and crisis clinic 24 hours a day, and has the capability of being a portal of entry into site emergency services. it is open 24 hours a day. psyche emergency services, which is based out of sentences could general hospital, does have an overnight capacity of 20. in the term 18. it is actually 20. also functions on an outpatient basis for the police and other human service providers in san francisco that are certified to authorize a 5150.

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